MEDICARE: BODY WORKS CUSTOM COMPRESSION LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	332B00000X	Durable Medical Equipment & Medical Supplies

General Provider Information

NPI Number	:	1215702261
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BODY WORKS CUSTOM COMPRESSION LLC

Provider Business Mailing Address
First Line	:	13926 HULL STREET ROAD
Second Line	:	PMB1007
City	:	MIDLOTHIAN
State	:	VA
Zip	:	23112
Country	:	US
Telephone Number	:	571-232-3179
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 LAKE ST APT 25
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-4705
Country	:	US
Telephone Number	:	571-232-3179
Fax Number	:

Authorized Official
Title or Position	:	MANAGING MEMBER
Name	:	NANCY BURKART
Credential	:	MT
Telephone Number	:	571-232-3179

Provider Enumeration Date	:	11/20/2023
Last Update Date	:	11/20/2023

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